Supreme Court quashes case against anaesthetist in 2002 medical negligence death
The Supreme Court held that the anaesthetist's actions could not be directly linked to the death in legal terms, while noting the post-mortem examination report.
In the first chargesheet, the Kerala Police named the surgeon, anaesthetist, and the nurse, but the Kerala High Court quashed it while allowing further investigation. (Credit: Pixabay) The Supreme Court on Monday quashed the criminal proceedings against an anaesthetist accused of medical negligence, which allegedly led to the death of a patient following a heart attack in 2002, saying her “actions were far too remote from the ultimate cause of death”.
A bench of Justices Pankaj Mithal and P B Varale noted that Supriya Kumari M K completed her shift at 5 pm and left only after ensuring the patient was stable, and when the emergency arose at 8 pm, other doctors on duty, including an on-duty anaesthesiologist, were physically available at the hospital.
The bench said, “Legally, an anaesthetist whose duty hours have concluded cannot be held criminally liable for a subsequent procedural error committed by a staff nurse. Even if the prosecution’s case is taken at face value, the fact that the appellant suggested a painkiller over the phone, such an act constitutes standard medical advice for post-operative pain, not gross criminal recklessness.”
“The failure of the nurse to accurately locate the epidural space might represent a deficiency in service (civil liability), but it fundamentally lacks the gross culpability or mens rea required to invoke Section 304-A IPC.”
The prosecution said the person died due to the negligence of Kumari, who, instead of administering anaesthesia to the patient post-surgery, instructed the attending nurse to do it. The nurse followed her instructions and administered the analgesic ‘sensorcaine’, a few hours after which the patient lost consciousness and collapsed.
However, the defence pointed to contradictions in the nurse’s statements: she initially said she had administered it on the surgeon’s advice, but later claimed she had consulted Kumari over the phone.
Writing for the bench, Justice Varale said, “Criminal liability under Section 304-A IPC necessitates a direct, proximate nexus between the negligent act and the death… Legally, the appellant’s actions were far too remote from the ultimate cause of death. The post-mortem certificate conclusively established that the deceased had an asymptomatic 80 per cent blockage in his coronary artery. The medical evidence proved that the immediate cause of death was acute coronary insufficiency resulting in a heart attack.”
“While the improper administration of the painkiller by the nurse might have failed to alleviate the surgical pain—which in turn induced stress that triggered the fatal cardiac event—this chain of events cannot legally be attributed to the appellant. Fastening criminal liability on an off-duty anaesthetist for an underlying, undisclosed cardiac condition stretches the legal doctrine of proximate cause beyond permissible limits.”
In the first chargesheet, the Kerala Police named the surgeon, Kumari, and the nurse, but the Kerala High Court quashed it while allowing further investigation.
Following this, a four-member expert panel was constituted, which in its final report dated July 10, 2008, unanimously opined that the death occurred due to gross negligence on the part of the hospital staff and that it could have been prevented if analgesia had been ensured by proper introduction of the drug by qualified persons.
While the criminal proceedings were underway, the family of the deceased pursued a parallel civil claim for medical negligence before the District Consumer Disputes Redressal Forum, Kannur.
“Following a rigorous evaluation of evidence, the Forum passed a judgment on 17.04.2017 holding the hospital, the surgeon (A1), and the nurse (A3) liable for deficiency of service, but categorically exonerated the appellant from any liability. The Forum expressly accepted that the appellant had not given any instructions to the nurse to administer the injection.”
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